Non-communicable diseases posing greatest health challenge in Bangladesh

Bangladesh has advanced significantly in the area of public health in recent years. Infectious diseases like malaria and tuberculosis are mostly under control, life expectancy has increased, and baby and maternal mortality rates have decreased. Nonetheless, a significant public-health obstacle to Bangladesh's advances in public health is an expanding epidemic of non-communicable diseases (NCDs).

The World Health Organisation (WHO) reports that NCDs such as diabetes, cancer, heart diseases, stroke, and chronic respiratory conditions account for about three out of every four fatalities in Bangladesh. So-called "lifestyle-related" diseases, they are becoming the country's largest health threat individually. Unlike infectious diseases, NCDs creep up unnoticed, take years to develop, and cost a fortune to treat.

The nation's disease pattern has been radically altered. Sanitation, public awareness and immunisation have reduced infectious diseases, but a faster rate of urbanisation, changed food habits, and lifestyle disorders have created a fertile ground for NCDs. The growth of such diseases is not an indicator of a failure in healthcare, but a failure in prevention.

Whilst living in a city offers many advantages, such as ease and connectivity, it has also resulted in sedentary lifestyles, pollution, and stress. The traditional rice- fish-and -vegetable diet is progressively being replaced by processed meals that are heavy in sugar, salt, and bad fats. Tobacco use is also shockingly high.

All this pathological diet, very little exercise, and smoking all together make for a "perfect storm" for the chronic conditions. To make things worse, preventive health consciousness is low. Health checks are regarded as a luxury, and most have medical attention only when symptoms have already set in full strength.

In addition to the pain of patients, NCDs are exerting immense pressure on the economy. Chronic illnesses favour targeting people at their most productive ages, degrading workforce engagement and contributing to dependency ratios. It was observed by Bangladesh Institute of Development Studies (BIDS) in its 2022 report that household healthcare expenditures of households with NCDs were around 40 per cent more than those of households without chronic diseases.

With minimal health insurance, these expenses are substantially out-of-pocket spending, driving many families to poverty. The cost of chronic medication and frequent hospitalisations can drain household savings and force people to borrow or sell property.

For a rising economy on the cusp of becoming an upper-middle-income one, such losses in productivity because of poor health are something to worry about.

A working population lost to chronic diseases cannot drive the type of growth Bangladesh desires to sustain. Environmental factors have aggravated the impact of natural disasters. As reported by the World Bank, exposure to fine particulate matter (PM2.5) accounts for more than 80,000 unnatural deaths in Bangladesh each year.

The city of Dhaka is considered one of the most polluted cities in the world, and is also a hotspot for numerous health issues associated with the respiratory system. Prolonged exposure to PM2.5 also increases the chances of heart attacks, strokes, and lung cancer.

Unplanned urbanisation has also reduced access to open spaces so physical exercise or recreation is hardly possible. Vehicle-dominated city planning has deprived citizens of the chance to perform even minimal physical activity.

The healthcare system, although appropriately decentralised by community clinics and upazila health complexes, is nonetheless very infectious-disease-focused. Most of the facilities are neither equipped nor trained to diagnose and treat chronic diseases.

There is a critical deficit of cardiology, oncology, and endocrinology experts, particularly in rural and semi-urban regions. Lack of regular screening for hypertension, diabetes, or cancer means that numerous patients are diagnosed late in the disease stage, and consequently treatment is more expensive and not as effective. The foundation of NCD control, preventive care, remains underfunded and underappreciated.

Bangladesh has recognised the NCD issues and initiated some positive and constructive actions. The Directorate General of Health Services (DGHS) National NCD Control Programme is central to the management of chronic diseases and focused on the improvement of lifestyle awareness and early detection.

Tobacco-control laws have made remarkable progress, including requirements for pictures on packaging and restrictions on advertisements. NCD management and prevention is another aspect of the Health, Population, and Nutrition Sector Programme (HPNSP).

Nevertheless, these approaches have not always been implemented consistently. Moreover, funding for the prevention of NCDs compared to curative therapies remains limited. Lack of enforcement of tobacco -control laws and insufficient regulation of air quality remain challenges. Without effective interministerial collaboration and consistent scrutiny, policies may remain just that - policies.

An exceptional chance to improve NCD management is provided by digital technology. Telemedicine and mobile health applications have significantly improved patients' ability to reach doctors and make appointments, especially in isolated areas. Expanding these innovations may ease the pressure on packed emergency rooms and make preventive care more easily accessible to people in their communities.

The corporate world must step up to the plate as well. Corporate health programmes, occupational health tests, and tie-ups with insurers can promote preventive health practices. ICDDRB and BRAC are two examples of civil-society organisations that have long shown their efficacy in public-health outreach. Their participation in NCD prevention could have a big impact.

As it stands, addressing Bangladesh's NCD issues requires a true, comprehensive approach. The health, economy, education, and environmental ministries must work in tandem to tackle the root issues that cause chronic diseases.

Important preventive actions ought to consist of bolstering primary healthcare with qualified personnel and diagnostic equipment, enforcing regulations pertaining to air pollution and tobacco use, promoting fitness regimens and yearly physicals, including health education in the curriculum of schools, and supplying chronic patients with reasonably priced health-insurance solutions. Political will, consistent finance, and widespread societal involvement are necessary for these initiatives.

The unprecedented public -health achievements in Bangladesh should not be overshadowed by the rise in avoidable, chronic health conditions. The time has come for a decisive move to strengthen the health system in the 'preventive' rather than 'reactive' mode. In this context, Bangladesh has to strengthen health 'promotion' rather than 'curative' practices.

The achievements in vaccination and family planning should be leveraged. With strong community structures, the enforcement of appropriate policies, and the right awareness-building initiatives, controlling the rising trend of NCDs is achievable. It's a monumental task, but it is certainly achievable. This can be done through viewing NCDs as a national development challenge instead of a health issue. Bangladesh can protect both its people and its development. The time to do that is now.

The writer can be reached at shakurajahan2024@gmail.com